Mochizuki H, Nakamura E, Hase K, Tamakuma S
First Department of Surgery, National Defense Medical College, Saitama, Japan.
Surg Today. 1993;23(9):771-6. doi: 10.1007/BF00311618.
Of a total 712 patients with left-sided colorectal cancer, 79 (11%) required emergency surgery due to severe obstruction by tumors. Of these 79 patients, 55 underwent tumor resection and anastomosis. Primary resection and anastomosis with intraoperative bowel irrigation was performed in 44 patients (primary group), while staged resection and anastomosis was performed in only 11 (staged group). In comparing the two groups, there was no significant difference in the rates of curative resection, being 76% versus 90%. However, the primary group demonstrated significantly lower rates of postoperative wound infection (P < 0.001), anastomotic dehiscence (P not equal to 0.05), and postoperative mortality, at 2% versus 18% (P < 0.05). The cumulative survival curve was also better in the primary group (P < 0.05). These favorable results of the primary group were confirmed by analyses which established that no bias of therapeutic backgrounds existed in either of the two groups. Thus, it was concluded that for left-sided obstructing colorectal carcinoma, intraoperative bowel irrigation, followed by primary resection and anastomosis, produces more advantageous results.
在总共712例左侧结直肠癌患者中，79例（11%）因肿瘤严重梗阻而需要急诊手术。在这79例患者中，55例行肿瘤切除及吻合术。44例患者（原发组）行一期切除吻合并术中肠道灌洗，而仅11例（分期组）行分期切除吻合。比较两组，根治性切除率无显著差异，分别为76%和90%。然而，原发组术后伤口感染率（P < 0.001）、吻合口裂开率（P≠0.05）及术后死亡率显著更低，分别为2%和18%（P < 0.05）。原发组的累积生存曲线也更好（P < 0.05）。对两组治疗背景无偏倚的分析证实了原发组的这些良好结果。因此，得出结论，对于左侧梗阻性结直肠癌，术中肠道灌洗后行一期切除吻合可产生更有利的结果。
